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Nurses Station Redesign For St. Marys Center, Inc.: Final Report Project Advisor: Eton Kwok ek2257@columbia.

com Project Partner: Bibi Nizam, RN Director of Nursing Andrea Cabral asc2138@columbia.edu Nicholas Cortes nic2101@columbia.edu Clark Granum cmg2146@columbia.edu Jesse Lute jpl2137@columbia.edu Elizabeth Kierstead- Primary Facilitator epk2104@columbia.edu Fundamental Design Principles using Advanced Computer Technologies- Section 003 Submitted: May 4, 2008

EXECUTIVE SUMMARY St. Marys Center, Inc., a Harlem based HIV/AIDS Center, faces issues with organization, efficiency of space usage, and amount of space in their Nurse Stations. Here we present our plan for the remodeling of the Nurse Station spaces. The major problem with the current stations that this project addresses is the lack of space for nurses, physicians, and administrators to carry out their daily operations. Each station, a very small room, contains a large staff bathroom. The removal of such bathrooms would dramatically expand the space the staff has available to work in, and would greatly improve the efficiency with which staff members can carry out their work. The new stations contain more storage units than the current ones, comfortably allow two to three staff members to work in the space simultaneously, and retain such standard nurse station components as a sink, refrigerator, medicine chart, shelving, charting space, and wall space for a bulletin board. The also accommodates a full set of office equipment and supplies, and allow for visibility inside cabinets. We are pleased that our design creates a more time and space efficient series of nurses stations, and that the spaces are much easier to maneuver through.

REPORT NARRATIVE Background Research St. Marys Center, Inc. is a non-profit institution located on 126th Street in Harlem that cares for patients fighting HIV/AIDS. Harlem has some of the highest rates of diagnosis and death, both in relation to the rest of the United States and New York City, with 241 diagnoses per 100,000 people. Roughly 32 of every 1,000 people living in Harlem with HIV/AIDS die, compared with Chelsea, where the death rate is slightly above 11 people out of 1,000. Harlem faces a uniquely tough fight against HIV/AIDS, and St. Marys Center plays an important part in this battle. St. Marys Center is housed in an old boarding school, and the building it is located in was not designed to serve as a live-in care center. The nurse stations are converted closets, and consequently bear little resemblance to traditional hospital nurse stations. Of the four floors of patients, there are stations on the second, third, and fifth floors. Caring for up to forty live-in patients at a time, the Center can become very busy. The second and fifth floor stations must cooperate in order to care for the patients of those floors, while the third floor station holds charts for patients on both the third and fourth floors. The stations need to be redesigned in order to fit clients needs of expanded space and improved organizational capabilities. Firsthand experience of the station demonstrated that there is barely enough space for two professionals in a station at a time, which is unacceptable at a facility responsible for forty patients. St. Marys Center provides a wide range of services for their patients. Furthermore, many different types of professionals require certain resources from the stations. The redesigned stations need to be equipped to accommodate the needs of all staff members from physicians and nurses to physical therapists and nutritionists. Formal Problem Statement St. Marys Center, located on 126th Street in Harlem, is a live-in community that cares for patients living with HIV/AIDS. The building is a converted school, and the three nurses stations are converted from what used to be a closet. This makes the nurses stations much too small for the needs of St. Marys staff. The current stations are inadequate in terms of the space provided, which leads to an inefficiency during the peak hours of use. An ideal solution to the lack of space would be to extend the station. In conjunction with complete reorganization, a new design will maximize efficiency of the storage of patient files and medication along with the other nursing supplies and the supplies of other specialists and professionals who use the space. Our clients expected us to establish whether it would be feasible to take out the bathroom wall, develop a plan to convert the old bathroom into additional workspace, expand storage space in the stations, and improve traffic flow throughout the spaces, which are currently very cramped. Design Specifications The purpose of the new design is to provide the various staff members of St. Marys with a work environment which is more conducive to the tasks that each employee must complete in order to effectively care for each patient. The rooms will essentially remain the same except for one

feature: the new rooms will be expanded by means of removing the bathrooms on the second and third floor stations, leaving only a small hand-wash sink. The new design must allow the nurses, nurse aides, and physicians to access the patients charts whenever they are needed, provide adequate writing surface area for charting activities, contain storage units for typical nurses station items, allow the employees to move about freely within the rooms, allow easy access to frequently used medical forms, and contain a workstation equipped with a computer, fax machine, printer, telephone, and other common office supplies. In the new design, the depth of the counter should be decreased to improve movement, although total countertop surface area should be increased. There must also be a storage unit that is practical in storing patient charts (which are approximately two-inch binders). The room must contain a refrigerator smaller than the current appliance, a small sink for hand washing, a computer, a printer, a fax machine, a bulletin board for memos, and most importantly, a door with a lock. To give the stations unique character and feeling, each station should have a different theme color (as they have now) to distinguish one floor from another. The new chairs must be small yet comfortable. The production of the final design will require a contractor. Finally, the design must be within the constraints of New York City Building Codes and should be fit for inspection. Final Design In our final design, we achieve each of the specifications required by the client. The most significant feature of our new design is the removal of the bathrooms from the second, third, and fourth floors, allowing for increased counter top space along the length of the right wall (facing in to the station), while the mounting of office equipment onto the wall allows us to use a shallower counter, making movement in the rooms aisles more facile. This new layout allows for the expanded charting space and ease of movement the client needs. Our design addresses the storage issue in two ways. The Meridian Vertical File is a more streamlined form of storage that allows the St. Marys Center staff to store patient files accessibly, all in the same location, as opposed to the current conglomeration of filing cabinets and shelf files. Additionally, it is easier for staff members to find objects stored in the cabinetry with the replacement of the current cabinet doors with transparent glass doors. This increased visibility lends itself to exactly the time efficiency the stations need, as staff members will spend less time searching for medication, supplies and other materials, so more staff members can use the space in the same amount of time. The downsizing of certain appliances also creates a more optimal environment. The replacement of the current sink with something smaller and more practical frees up room in the current bathroom for the refrigerator, which is currently located under the work area counter. We think the space used now by the refrigerator could be better used by filing cabinets. The current refrigerator is also unnecessarily large, so our model incorporates a more space efficient, smaller refrigerator.

In addition to charting space and storage, traffic flow was another important consideration for us when we developed our final design. A relatively obvious yet slightly expensive solution to this issue is smaller, more navigable stools to replace the bulky current seating that can be difficult to get around. Further, we create a better working space for staff members that need some separation to do computer work for more extended periods of time. Such a space is created in the new back right corner of the space at a corner desk, so the larger, more comfortable seating needed for more time consuming office work will not take up space in busier parts of the nurse stations main aisle. Our design did not go through too much evolution in the process of creating the ultimate deliverable, because our problem is fairly straightforward. We did some experimentation with a computer mount component, which we ultimately decided against due to cost conservation motivations. We had a bit of trouble finding an affordable professional custom cabinet maker that could meet our specifications. We considered anchoring modular storage cabinets meant to rest on the floor to the wall, that could be custom built with transparent doors. We ultimately decided to keep the framework of the current cabinetry, replacing the doors with transparent doors for improved visibility. Our design plans were also modified by the fact that the refrigerator we selected was too tall to fit under the work-area countertop, requiring us to move the refrigerator to the back of the space, near the sink. This adjustment actually proved beneficial, as it freed up the extra filing cabinet space our client needs. A major factor that influenced the groups approach to the problem we faced was the information that we could remove the bathroom walls, that we discovered in the plans for the old schools closet space that had no wall where the current one stands. Budgetary constraints also played a major role in our design choices, as we always kept cost minimization in mind. Second Floor Current Model

Second Floor Implemented Model

Third Floor Current Model

Third Floor Implemented Model

Fifth Floor Current Model

Fifth Floor Implemented Model

Layout of New Second Floor

Layout of New Third Floor

Layout of New Fifth Floor

Second Floor Current Station

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Transition Plans and User Documentation In this project, we endeavored to redesign a series of nurses stations, in small spaces. Nurse station design is a topic with a well-established body of methods and popular layout options. Because we had to work with a long, narrow space, closed on three sides, none of these standard layout options offered solutions for the St. Marys Center nurses stations. However, the document Planning a Nurse Station for a Clinical Foundation by Herman Millers Healthcare division was immensely helpful in starting us on the right path in terms of considering the specifications of standard nurse stations. If the client wishes to expand upon the work of this project, it could introduce more elaborate storage options in the cabinetry, providing for smaller sub-compartments to store smaller objects. For future engineering design teams, we would communicate that we had an overall positive experience with St. Marys Center. We would remind such a team of the critical importance of keeping open communication throughout the duration of the project. In our experience, having the discipline to maintain communication throughout the project was one of the more difficult aspects of the project. We would recommend using phone (versus e-mail) in general, for more candid, immediate communication. We would also recommend that future engineering design teams visit the site early on, as we did, as this dramatically altered our perception of the problems we faced. We outline our process for those looking to duplicate it in future nurse station redesign projects. Because our project was about creating a new layout, as opposed to a new object or structure, we found that the New York City Department of Buildings was a good place to start, so we could see if we could expand the room into surrounding spaces, and get a sense of the structural aspects of the room. Next, the New York City Building Codes were a good place to establish the legal restrictions of our design, and to determine whether certain wall removals were in order. Next, we determined our customer and engineering specifications, and then chose appliances, furniture, and a contractor to fit these needs, with cost considerations in mind. Next, we assembled the project budget, and created a model, using the selected appliances and furnishings. Our solution is an assembly of many smaller solutions we found on the market that work to uniquely serve the clients space and budgetary requirements. Thus, we do not consider the possibility of patent application here. The installation of the countertops requires special consideration. They should be installed to the sheet rock of the wall with wall anchors. The contractor should consult the client for their aesthetic preferences concerning these wall anchors. There are also unique specifications for the custom-made glass doors for the cabinets, which should be ordered from www.cabinetdoorshop.com with Pine Rustic wood species, SEI Edge Profile, Regular Inside Profile, No Finger Pull, overlay hinge & plate, 2.5MM bore distance, 2.5 bore pattern, no Blumotion for doors and left drill specs. There should be a glass frame with 2 3/8 stiles and rails.

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Alternative Solutions In the process of creating this plan, the group considered many components of a design solution that were ultimately discarded for a variety of reasons. Some such ideas included an idea to install a drop-down counter on the left wall (facing into the space), rejected because we thought it could impede movement in the space while it was lifted, and because we wanted to keep the left wall open and an idea to include an adjustable computer wall mount that was rejected with budgetary constraints in mind. We considered a plan where we would extend the cabinets all the way up to the ceiling, but we rejected this plan when we realized that NYC Building codes require clearance around the sprinklers and vents. An alternative solution still in consideration would be the option of taking out the bathroom on the fifth floor, which would free up additional space while adding to the ultimate sticker price of the project.

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APPENDICES Gantt Chart

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Product Design Specifications Product title St. Marys Center, Inc. Renovated Nurses Stations Purpose To provide staff members (nurses, nurses aides, physicians, pharmacists, therapists, social workers) with an organized and efficient work environment New features Room expansion (on second and third floors) Need for product Workers and administrators of the Center have encountered difficulties in performing ordinary tasks due to the limited amount of space in the stations. Currently, no more than one person can comfortably perform their duties at a time. Functional performance Allows staff members to easily access patients charts Provides charting area (writing space) Has increased storage space Allows staff members to freely move about the room Allows storage space for medicine cart Allows staff members visibility of items stored in cabinets Provides computer workstation area equipped with a fax machine, printer, and office supplies Allows for easy access to frequently used forms Physical requirements Counter space for writing (more than in current design) Practical storage for charts (shelves) Cabinets with transparent doors Small refrigerator (smaller than current) Small hand-wash sink Computer, printer, and fax Door with lock Bulletin board Human factors Different theme colors in each station Furniture (specifically chairs) should be comfortable and provide productive work atmosphere Corporate constraints Independent contractor must be hired for demolition of 2nd and 3rd floor bathrooms

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Legal requirements Must follow regulations stipulated by New York Building Codes Must pass New York State Department of Health Nursing Home inspection

Customer Requirements 1,2

3-5

Engineering Requirements The wall on the 2nd and 3rd floor separating the bathroom should be removed Several models: One in which the wall is not removed for the 4th floor, and lower cost solutions for the 2nd and 3rd floors Glass see through cabinets, along with painted walls Mount fax, printer, and phone on wall, and decrease counter space

Justification/Rationale Based on our analysis, this maximizes space efficiency

Several budget options to provide Saint Marys Center with flexibility

1,2,5

1,2,5

Place the computer toward the back of the station

Allows nurses and doctors to easily see medicinal supplies in cabinets By mounting all of these on the wall and decreasing the counter space actual writing space is kept the same while floor space is increased Allows for easier access to files and more sitting room for computer operator

1. 2. 3. 4. 5.

The nurses station should have space for 3 people The station should accommodate a filing and computer system Aesthetically appealing Should stay within budget (various designs) Ease of access

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Budget Estimates And Materials Lists * Prices in bold are sums of prices not in bold (labor and materials) where applicable ** Subtotals are sums of quantities in bold Service Labor Item- Description Price x Quantity $2280 x 2* $564 x 2 $1716 x 2

BATHROOM DEMOLITION wall demolition removal of sinks, toilets, doors, and flooring

BATHROOM RENOVATION $5786 x 1 removal of sinks, toilets, doors, and flooring installation of porcelain floor tiles porcelain tiles- Ply-Gem 13 x 13 Verona Giallo, White $1.78 x 40 installation of new sinks and toilets sink- Crane Pedestal To-Go With Faucet, White $106 x 1 toilet- Kohler Rialto One-Piece Toilet, White $329 x 1 large toilet tissue dispenser for 9" rolls $15.95 x 1 installation of new doors door- ReliaBilt 32" Interior Door Slab $24.59 x 1 hardware- Kwikset Maximum Security Cameron $12.97 x 1 Knob Style Privacy Door Lock painting of walls, doors, and ceilings primer- Valspar 1-Gallon Interior Latex Multi-Purpose $19.48 x 1 wall paint- Valspar 1-Gallon Signature Colors Interior Latex Eggshell Finish Wall & Trim Paint- color of clients choice $26.98 x 1 trim paint- Valspar 1-Gallon Signature Colors Interior Latex Eggshell Finish Wall & Trim Paint- color of clients choice $26.98 x 1 FLOORING- 2ND AND 3RD FLOORS $4702 x 2 removal of current vinyl flooring installation of porcelain floor tiles porcelain tiles- Ply-Gem 13 x 13 Verona Giallo, White $1.78 X 100 FLOORING- 5TH FLOOR $2479 x 1 removal of current vinyl flooring installation of porcelain floor tiles porcelain tiles- Ply-Gem 13 x 13 Verona Giallo, White $1.78 X 60 PAINTING- 2ND AND 3RD FLOORS $765 x 2 painting of station walls, ceilings, and entrance doors primer- Valspar 1-Gallon Interior Latex Multi-Purpose $19.48 x 3 wall paint- Valspar 1-Gallon Signature Colors Interior Latex Eggshell Finish Wall & Trim Paint- color of clients choice $26.98 x 3

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trim paint- Valspar 1-Gallon Signature Colors Interior Latex Eggshell Finish Wall & Trim Paint- color of clients choice $26.98 X 1 PAINTING- 5TH FLOOR $602 x 1 painting of station walls, ceilings, and entrance doors primer- Valspar 1-Gallon Interior Latex Multi-Purpose $19.48 x 1 wall paint- Valspar 1-Gallon Signature Colors Interior Latex Eggshell Finish Wall & Trim Paint- color of clients choice $26.98 x 1 trim paint- use from bathrooms STATION FURNISHINGS- 2ND AND 3RD FLOORS refrigerator- GE 4.3 Cu. Ft. Spacemaker Compact Refrigerator, white Corner Desk- Modular Furniture System Doctor's Stool, Boss Durable Caressoft with Back Cushion Panel Workstation Bridge Piece Panel Workstation Corner Surface File Cabinet- Veridian Vertical Office Stools- Boss Seating Set of custom glass cabinet doors- Cabinet Door Shop STATION FURNISHINGS- 5TH FLOOR refrigerator- GE 4.3 Cu. Ft. Spacemaker Compact Refrigerator, white File Cabinet- Veridian Vertical Office Stools- Boss Seating Set of custom glass cabinet doors Panel Workstation Bridge Piece DEBRIS REMOVAL 20 yard dumpster rental $250

$158 x 2 $948 $68.99 x 2 $422 x 2 $557 x 2 $500 x 3 $99.99 x 4 $1000 x 2

$158 $500 $99.99 x 2 $1000 $422

MISCELLANEOUS EXPENSES $1000 paint brushes, door thresholds, painting tape, sandpaper, plaster, grout, nails, screws, hinges, light switch covers, outlet covers, etc.) SUBTOTAL** $35,150.92 OPTIONAL ITEMS Item- Description Quantity Automatic Sink Faucet MAC's "BEST SELLER" Price x

$169.99 x 3

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Automatic Soap Dispenser ASD-3 Automatic Touchless Paper Towel Dispenser TEAR-N-DRY Purell NXT Space Saver Hand Sanitizer Dispenser

$49.99 x 3 $99.99 x 3 $7.99 x 3 SUBTOTAL $1088.82 GRAND TOTAL $36,239.74

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List of Resources 516 W 126th Street Building Plans- Alt 6761947. New York City Department of Buildings. 21 Mar 2008. Dieter, George E. Engineering Design. Boston: McGraw Hill, 2000. Dolkart, Andrew. Hints on Researching New York City Buildings. Columbia University. 23 Mar. 2008. http://www.columbia.edu/cu/lweb/img/assets/7495/Hints.doc. Gates, George Bouldin and Rashi Rohatgi. Adapting Popular Opinion Leader to Meet the Growing Needs of the MSM of the Color Online Community. Harlem United. www.harlemunited.org 1 May 2008. www.harlemunited.org Medication Cabinets (Nurse Station). RN Showcase. 23 March 2008. http://www.rnshowcase.com/showcase.php/catid-24/catnameMedication%20Cabinets%20(Nurse%20Station)/ New York City Building Codes. New York City Department of Buildings. 23 Mar 2008. http://www.nyc.gov/html/dob/html/reference/code_internet.shtml Planning a Nurse Station for Clinical Function. Herman Miller Healthcare. 25 Feb. 2008. www.hermanmiller.com/hm/content/research_summaries/wp_nursesstation1000.pdf St. Marys Center, Inc. 1 Mar. 2008. http://www.stmarysharlem.com.

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